Difficult Closure of Open-Window Thoracostomy After Drainage of an Infected Pulmonary Bulla

Percutaneous drainage can be used to treat infected pulmonary bullae unresponsive to antibiotics; however, it carries a high risk of bronchopleural fistula and empyema. We report the case of an elderly man with an infected pulmonary bulla successfully treated with percutaneous drainage followed by open-window thoracostomy (OWT) for persistent air leakage. Although the infection was controlled, closing the OWT was challenging due to recurrent bronchial fistulae despite repeated surgeries. This case highlights the need to carefully identify and close all bronchial openings in the cyst wall to achieve successful closure after OWT in patients with severely infected bullae.